The Cardiovascular System Rehab Careers 2-26-18

Standard Outline the gross and cellular anatomy and physiology of the musculoskeletal, neurological, and cardiovascular systems. Review the gross anatomy of the other systems studied in previous courses.

Objective By the end of class, student will be able to Recognize main functions of the heart Identify the 4 chambers of the heart Understand Temp, Pulse, Respirations

Physiology Also known as Circulatory System Carries blood around the body Transports nutrients and oxygen to cells all over the body Transports wastes (urea, carbon dioxide, salt) to excretory organs It is composed of the heart, lungs, and blood vessels

Key Terms Pulmonary – means anything dealing with the lungs Cardiac – means anything dealing with the heart Heart: a muscular organ that pumps blood to the lungs and the body. Lungs: organs that take in oxygen from the air and remove carbon dioxide from the body.

The Heart Muscular organ Size of a closed fist Weighs 12-13 oz

CARDIOLOGY A PERSON’S HEART WILL BEAT APPROXIMATELY 100,000 TIMES A DAY, EVERY DAY IMAGINE TRYING TO SQUEEZE A TENNIS BALL 70 TIMES A MINUTE…..THAT IS WHAT YOUR HEART DOES EVERYDAY

Chambers and Valves Upper chambers – RIGHT ATRIUM and LEFT ATRIUM Lower chambers – RIGHT VENTRICLE and LEFT VENTRICLE Four heart valves permit flow of blood in one direction

VALVES Tricuspid – 3 flaps or cusps – prevents backflow into R atrium Pulmonary – 3 flaps – prevents backflow into R ventricle Mitral (bicuspid) – 2 flaps – prevents backflow into L atrium Aortic – prevents backflow into L ventricle

CARDIAC CYCLE Creates Heart sounds Heard through stethoscope “LUB-DUB” sound 1st sound – longest and loudest closure of Tricuspid and Mitral valves 2nd sound – closure of aortic and pulmonary valves If valves do not close properly – you will hear an extra sound called a heart murmur

Pulse Wavelike pulsation of heartbeat in arteries Palpate superficial artery with pads of three middle fingers Veins do not pulsate Counting a patient’s pulse is a method of determining the patient’s heart rate. Count the patient’s pulse for 1 minute.

Factors Affecting Pulse Normal heart rate decreases with age Newborn heart rate is higher than an adult’s heart rate Athletic people will have decreased rate Heart rate increases with exercise, emotion, stress, fear, and anxiety Heart rate is affected by pregnancy, hyperthyroidism, and medications Fever increases heart rate Many factors affect pulse rate. Think of all the things that increase your heart rate and decrease your heart rate.

Heart Rate Measured in beats per minute Normal Heart Rate Adults – 60-100 Abnormal Heart Rates <60 BPM – Bradycardia >100 BPM – Tachycardia Your heart rate is: 70 BPM (70 beats per minute)

Heart Rate State if normal, bradycardia, tachycardia 176 BPM 44 BPM

Pulse Sites Many pulse points in the body Any area where pulse can be felt May be done to evaluate circulation in body area Count heart rate Compressed to control bleeding Pulse points can also be used to control bleeding in the event of an injury or accident.

Major Pulse Sites Temporal Carotid Brachial Radial Femoral Popliteal Pedal - Dorsalis pedis and posterior tibialis Head—neck—arm—wrist—upper leg—knee—foot

Carotid Carotid—groove between the larynx and sternocleidomastoid muscle at side of neck

Brachial Brachial—antecubital space of arm (the bend)

Pulse Points Radial—distal part of forearm, inner aspect of wrist, base of thumb The most common site to count a patient’s pulse is in the wrist area of the arm. This is the radial artery.

The measurement of core body heat TEMPERATURE The measurement of core body heat

Temperature Body temperature regulated by hypothalamus Important part of homeostasis Physiologic factors affect temperature Average body temperature—98.6 “Normal” 98.6 Usually over 100.4 means infection/illness Time of day affects temperature: temperature is lower in the am and higher in the pm A patient’s temperature is a sign of homeostasis or infection or illness.

Temperature Terminology Hypothermia- low body temperature, below 95 degrees rectally. Death occurs if temperature is less than 93 degrees for a period of time. Hyperthermia- high body temperature, over 104 degrees. Fever is a temperature above 101 degrees. Pyrexia is another term for fever. Febrile means “with fever”. Afebrile means “without fever”

ROUTES TO MEASURE TEMPERATURE Oral: By mouth Rectally: By rectum Axillary: Under the arm in the armpit Tympanic: In the ear

RESPIRATION The mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

Respirations Respiration is “the process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract”. Normal adult respiratory rate is 12-24 breaths per minute. Respiratory rate should be counted for 30-60 seconds just following pulse assessment. Why following pulse? Act like you are continuing to check pulse. If patient knows you are assessing breathing, they may change their rate of breathing. You are counting the number of times their chest rises and falls.

Documentation Character or respirations should be noted. This refers to depth and quality. Deep, shallow, labored and difficult all refer to character. Rhythm should also be addressed. This is regularity of respirations. Are they regular and even or irregular? When you assess your partner you need to write these down.

Respirations Inspiration and expiration Diaphragm is muscle involved with breathing Only vital sign that can be easily controlled by a healthy adult The medical assistant counts respirations by watching the patient’s chest rise and fall. Each inspiration and expiration count as one respiration.

RESPIRATION Measured in breaths per minute Normal range is 12 - 24 breaths per minute Greater than 24 is tachypnea Less than 12 is bradypnea Watch for rate, depth, quality of breath, and difficulty in breathing

Temperature, Pulse, Respirations https://www.youtube.com/watch?v=H_UJoS4tMuc

Practice TPR

O2 Saturation Measured in percent using a pulse oximeter Normal Range 94-100% for healthy adults Breathing room air contains 21% oxygen. Anyone who is not achieving the critical blood oxygen saturation level of 90% may need oxygen

O2 Sat Non invasive process involves inserting a finger (can be used on the ear or a toe as well) into the device where a red light calculates the redness of the blood pulsing through the finger. 

O2 Saturation Oxygen saturation levels measure the degree to which the hemoglobin contained in the red blood cells (erythrocytes) has bonded with oxygen molecules. Oxygen is taken in by the lungs when we breathe in

PAIN PAIN is personal Everyone’s pain level will be different How do we quantify it?

Pain Scales Numeric: 1-10 Wong-Baker Faces

PAIN SCALE

How to assess Pain Ask Patient: 1. Are you having any pain? Where is it located? If they say yes, proceed to next question 2. On a scale of 0 to 10 with O being no pain and 10 being the worst pain you can imagine, how much does it hurt right now? 3. What is the quality of your pain? Is it burning, stabbing, gnawing, shooting, cramping?

Descriptive Pain Words Aching. Cramping. Fearful. Gnawing. Heavy. Hot or burning. Sharp. Shooting.

How to assess pain 4. Does it radiate anywhere else? 5. What relieves your pain? 6. When does your pain start? How often does it occur? Has its intensity changed? How long does it last?

TERMS Eupnea - Normal breathing Orthopnea - Sitting upright to breath more easily Apnea - No breath Hyperpnea - Fast, deep breathing Tachypnea - Fast, shallow breathing Bradypnea - Slow breathing Dyspnea - Painful or difficult breathing Tachycardia - Pulse rate in excess of 100 bpm Bradycardia - pulse rate less than 60 bpm